From the Guidelines
Testing for Polycystic Ovary Syndrome (PCOS) should involve a combination of physical examination, medical history review, blood tests, and imaging studies, with a focus on measuring hormone levels, including testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and sometimes anti-Müllerian hormone (AMH), as well as assessing biochemical hyperandrogenism using total testosterone (TT), free testosterone (FT), and free androgen index (FAI) as first-line laboratory tests, as recommended by the 2023 International PCOS Guidelines 1.
Key Components of PCOS Testing
- Physical examination and medical history review to evaluate symptoms such as irregular periods, excess hair growth, acne, and weight gain
- Blood tests to measure hormone levels, including:
- Testosterone
- Luteinizing hormone (LH)
- Follicle-stimulating hormone (FSH)
- Anti-Müllerian hormone (AMH)
- Assessment of biochemical hyperandrogenism using:
- Total testosterone (TT)
- Free testosterone (FT)
- Free androgen index (FAI) as first-line laboratory tests
- Imaging studies, such as pelvic ultrasound, to examine the ovaries for multiple small follicles (cysts) and to check for enlarged ovaries
Importance of Biochemical Hyperandrogenism Testing
The 2023 International PCOS Guidelines recommend using TT, FT, and FAI as first-line laboratory tests to assess biochemical hyperandrogenism in the diagnosis of PCOS 1. These tests are essential in identifying hormonal imbalances characteristic of PCOS, such as elevated testosterone and LH levels. If TT, FT, or FAI are not elevated, and clinical suspicion is high, health professionals could consider measuring androstenedione (A4) and dehydroepiandrosterone sulfate (DHEAS), noting their poorer specificity 1.
Role of Imaging Studies
Imaging studies, such as pelvic ultrasound, play a crucial role in the diagnosis of PCOS, particularly in examining the ovaries for multiple small follicles (cysts) and checking for enlarged ovaries 1. However, the diagnosis of PCOS requires a combination of clinical, biochemical, and imaging findings, and no single test can definitively diagnose the condition.
From the Research
Testing for PCOS
To test for Polycystic Ovary Syndrome (PCOS), several methods can be employed, including:
- Measurement of circulating androgens, with free testosterone being the most important 2
- Assessment of prolactin and FSH levels when menstrual dysfunction is present 2
- Evaluation of menstrual cycle regularity and presence of hyperandrogenism, such as hirsutism and acne 3, 4
- Physical examination for signs of hyperandrogenism, including acne, hirsutism, and androgenic alopecia 2
- Calculation of the Ferriman-Gallwey score to assess the degree of hirsutism 5, 6
Diagnostic Criteria
The diagnosis of PCOS involves the presence of:
- Hyperandrogenism, which can be clinical (hirsutism, acne) or biochemical (elevated androgen levels) 2, 3
- Oligomenorrhea or anovulation, which can be assessed through menstrual history and hormonal evaluations 2, 5
- Polycystic ovaries on ultrasound, although this is not a required criterion for diagnosis 5
Laboratory Tests
Laboratory tests that may be used to support the diagnosis of PCOS include: